(a)  Recovery shall apply to the estates of individuals under age 55 who seek Medicaid coverage for costs of care in a medical institution and who cannot reasonably be expected to be discharged to return home.

(b)  For purposes of estate recovery, medical institution means licensed nursing facilities, intermediate care for the mentally retarded facilities, nursing facility level of care in hospitals, or psychiatric inpatient care in a general hospital, psychiatric hospital, or mental institution. 

(c)  A determination that an individual cannot reasonably be expected to be discharged to return home is made when the individual seeks placement in or has been admitted to a medical institution using the following evidence:

(1)           Admission forms for level of care, physician written statement of discharge plans, or plans of care which indicate care needs are not of temporary duration, or

(2)           Individual continues to be a resident of a medical institution at the end of a temporary stay predicted by his physician at the time of admission to be no longer than six months in duration.

(d)  Notice of the determination that the individual is residing in a medical institution cannot reasonably be expected to be discharged to return home shall be given to the individual, or to his parent/guardian/responsible person if the individual is incompetent, within three work days after the determination.  The notice shall explain the right to request a reconsideration review, and the time limits and procedures for doing so.

(e)  The individual or his parent/guardian/responsible person may request a reconsideration review of the determination under Section .0200 of this Subchapter.


History Note:        Authority G.S. 108A-70.5; 42 U.S.C. 1396p.;

Temporary Adoption Eff. May 6, 1996 to expire on July 1, 1996, or the last day of the 1996 session of the General Assembly, whichever is later;

Temporary Rule Expired on July 1, 1996;

Eff. July 1, 1996.